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Introduction:
Teeth hypersensitivity is an exaggerated response to a sensory
stimulus that usually causes no response in normal healthy teeth. As a
source of chronic irritation, teeth hypersensitivity affects eating, drinking,
and breathing. Hypersensitive teeth are characterized by transient pain
in response to evaporative, tactile, thermal, electrical or chemo-osmotic
stimulation of exposed dentin in teeth where no other defects or
pathology exist (9).
Etiologies(causes)
I) Preoperative etiological factors:
a) Bacterial
b) Chemical - Osmotic
c) Mechanical
d) Thermal
e) Idiopathic
response to stimuli, and dull ache pain if pulpal changes occur which
might represent an irreversible pulpitis (21,51).
*Greater degree of sensitivity happens when dental caries passes the
DEJ. as caries penetrates further into the tooth, sensitivity lessens until
pulp becomes involved (31).
*Deeper in dentin and near the pulp, the number of dentinal tubules is
higher, the bigger the diameter of the dentinal tubules, the shorter their
length, the higher the permeability of the dentinal fluids and
consequently the higher the degree of hypersensitivity (49).
b) Chemical-Osmotic:
*Erosion is defined as the dissolution of teeth by acids which are not
of bacterial origin. When an acid or an osmotic agent like sugar
adhere to the margins of leaky restoration or exposed dentin that will
affect the flow of dentinal fluid and result in hypersensitivity.
*Erosion can be of Extrinsic or Intrinsic origin (81,64).
*Extrinsic erosion results of exposure to extrinsic food, fluid or
agents, such as citrus fruits, pickled food, fruit juice, carbonated
drinks, wines, ciders, vitamin C, some mouth rinses with low PH and
bleaching agents especially those delivered in a vacuum formed trays
for In home applications (29,39,3).
*Intrinsic erosion may result from gastric reflux as in Hiatus hernia,
(60)
alcoholism, eating disorders like bulimia nervosa . In case of
intrinsic erosion the palatal aspect of the upper anterior teeth and the
occlusal and buccal surfaces of the lower posterior teeth are primarily
affected (61,7).
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c) Mechanical
i) Attrition:
is defined as wear of teeth at sites of direct contact between teeth.
Attrition is associated with occlusal function and can be aggravated by
habits or parafunctional activities which is known as bruxism (69).
ii) Bruxism:
The aetiology of bruxism is unknown but it could be associated with:
• Sleep disorders as obstructive sleep apnea and Snoring.
• Malocclusion
• High consumption of alcohol and heavy smooking
• Stress, digestive problems.
• Disorders as Huntington and parkinson’s diseases
• Drugs as: MDMA, cocaine
The bruxism results in hypersensitivity to heat and cold, fractured
teeth and fillings, musculofacial pain and headache, stiffness and pain
in the joints and earache.
iii) Abrasion:
It is defined as the wear of teeth caused by objects other than other
teeth such as tooth brush/toothpaste abrasion, scaling and root
planning and pipe smoking (46).
iv) Abfraction:
It is defined as the wear of teeth at the cervical portion as a result of
occlusal loading that leads to cuspal flexure, this in turn results in
compressive and tensile stresses at the cervical fulcrum area of the
Teeth Hypersensitivity 4
teeth with the resultant weakness and gradual loss of the cervical
portion (60).
v) Gingival recession:
It may result from tooth brush abrasion, malocclusion, excessive
brushing and flossing. Gingival recession results in exposure of
cementum which less resistant to abrasion and acids than enamel, that
consequently will lead to exposure of dentin and hypersensitivity (6).
vii) Trauma
Can involve fracture of enamel only with little or no sensitivity,
enamel and dentin with moderate to sharp pain with stimuli typically
evaporative, thermal, mechanical (tactile) or osmotic, pulp
involvement with dull ache spontaneous pain, or fracture of the root
which will result in tenderness to touch or percussion. The trauma
might result in no damage at all but tenderness to touch as a result of
trauma to the periodontal ligament that can subside later (15).
Teeth Hypersensitivity 5
iii) Vibration:
Cause a rebound response as a result of using eccentric burs,
which can result in necrotizing effects on dentin.
i) Polymerization shrinkage
The polymerization shrinkage results in stresses at the
composite/tooth interface resulting in microleakage, microcracks or
deformation of tooth structure. Microleakage can result in secondry
caries formation and the consequent teeth hypersensitivity.
Stresses are greatest in cavities with high ratio of C factor (ratio of
bonded surfaces to unbonded surfaces), decreasing C factor will
result in decreasing stresses from polymerization shrinkage (20).
iii) Microleakage
Any restoration though exhibits clinical satisfactory adaptation,
shows some leakage. The ingress of fluids and micro organisms
can be the cause of dentinal hypersensitivity in addition to the fluid
movements within the dentinal tubules (47).
v) Fractured restoration
Exposes dentin, admits oral fluids and microbes which will cause
recurrent caries and dentin hypersensitivity.
vi) Cracked tooth
Pain on biting and eating citrus fruits, this sharp pain will
disappear when pressure is released. Commonly happens in teeth
with large restoration, direct gold filling with excessive
condensation forces and cast restoration without proper
consideration for cusp protection (42).
vii) Galvanism
When two dissimilar metallic restorations brought into contact
the current will pass between them and a galvanic stimuli will be
generated. Hypersensitivity is usually felt in the tooth containing
the restorative with the lower potential, i.e: Amalgam (49).
The degree of hypersensitivity will depend on some factors as:
The difference in the electrical potential between the dissimilar
metals, the electrical resistance of dentin and soft tissues, presence
of base and its thickness, the current intensity, the pulpal condition
and the patient threshold.
a) History:
conjunction with fluoride pastes (50) or solutions (68) and reportedly reduces
Dentin hypersensitivity. (68,50)
Potassium nitrate: Potassium nitrate, which usually is applied via a
desensitizing toothpaste, also can reduce dentin sensitivity when applied
(34)
topically in an aqueous solution or an adhesive gel. Potassium ions do
reduce nerve excitability in animal models. (56, 42)
Oxalates: Oxalate products reduce dentin permeability and occlude
(27, 58)
tubules more consistently in laboratory studies than they do in
clinical trials. (54)
Calcium phosphates: Calcium phosphates may reduce dentin sensitivity
effectively. Calcium phosphates occlude dentinal tubules and decrease
dentin permeability. (13)
Orajel Tooth Desensitizer : treats pain from sensitive teeth by blocking
dentinal tubules preventing excitation of the tooth nerve.
NovaMin: is the brand name of a particulate bioactive glass that is used
in dental care products. It consists of 45% SiO2, 24.5% Na2O, 24.5%
CaO and 6% P2O5. it delivers an ionic form of calcium, phosphorus,
silica, and sodium which are necessary for bone and tooth mineralization.
NovaMin can be used an effective, non-toxic alternative to fluoride.
Casein Phosphopeptides: It is a water based topical cream, sugar free
with bioavailable calcium and phosphate, in the form of CPP-ACP
(casein phosphopeptides- amorphous calcium phosphates. Recent studies
reported that it provides extra teeth protection and neutralize acids from
acidogenic bacteria and from other external and internal acid sources.
Adhesives and resins: Because many topical desensitizing agents do not
adhere to the dentin surface, their effects are temporary. Stronger and
more adhesive materials offer improved and longer-lasting
desensitization. In the 1970s,
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